Systematic review of impaired cerebrovascular autoregulation and adverse patient-centred outcomes in critically ill patients and patients after high-risk surgery


Nina Li¹, Andrew Cheng^2,3

1. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia 
2. Department of Intensive Care, St George Hospital, Liverpool, NSW, Australia 
3. St George & Sutherland Clinical School of Medicine, University of New South Wales, Sydney, NSW, Australia.

Background

For patients experiencing critical illness following high-risk surgery, it remains unclear whether impaired cerebrovascular autoregulation (CVAR) is associated with adverse outcomes. 

Aim

To evaluate any association between impaired CVAR and adverse outcomes in critically ill patients and high-risk surgical patients. 

Methods

MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were systematically searched through to 8 March 2019. The primary outcome was acute neurological dysfunction. Risk of bias and the quality of evidence was evaluated using the Newcastle-Ottawa Scale and GRADE approach respectively. 

Results

Fourteen quantitative studies and no randomised controlled trials met the inclusion criteria [critical illness (n=8), high-risk surgery (n=6)]. No reliable conclusions can be drawn from the studies evaluating acute neurological dysfunction due to the high risk of bias and low-quality evidence. 

Conclusion

There is no conclusive evidence for any association between impaired CVAR and adverse patient-centred outcomes in critically ill or high-risk surgical patients.